WEBVTT - Peyronie’s Disease Surgery: What Patients Should Know 0:00:00.560 --> 0:00:05.440 Let's talk about it. Let's talk about the may Hero. 0:00:08.800 --> 0:00:13.880 Let's talk about it. Let's talk about the man hero. 0:00:16.960 --> 0:00:20.480 Welcome to the Welcome back to the mailroom, everybody. 0:00:21.040 --> 0:00:22.759 We are here with Jordan run Todd. 0:00:22.760 --> 0:00:26.240 I'm also joined by Professor Matt Ziegelman from the Mayo 0:00:26.280 --> 0:00:27.880 Clinic in Rochester, Minnesota. 0:00:28.320 --> 0:00:29.600 And before I get into that. 0:00:29.520 --> 0:00:32.040 I just want to reorient people that were in the 0:00:32.040 --> 0:00:35.519 middle of our series on Peroni's disease. We've had some 0:00:36.440 --> 0:00:40.080 natural history disease, state who gets it, how do we 0:00:40.159 --> 0:00:40.560 get it? 0:00:41.000 --> 0:00:41.960 What are the treatments? 0:00:42.120 --> 0:00:45.040 And the reason that I'm bringing in Professor Ziegelman is 0:00:45.080 --> 0:00:47.360 because he is really one of the most renowned surgeons 0:00:48.120 --> 0:00:50.559 in the country and therefore really in the world on 0:00:50.720 --> 0:00:53.159 dealing with some of the more complex cases of Pirnie's 0:00:53.200 --> 0:00:55.840 disease in the OAR and Matt and I have shared 0:00:55.920 --> 0:00:58.720 and and have talked back and forth about some of 0:00:58.760 --> 0:01:01.560 the more complicated cases that we've dealt with over our careers, 0:01:01.600 --> 0:01:04.040 and so he's a wonderful resource for me as a 0:01:04.080 --> 0:01:07.920 surgeon surgeon but also is able to break down some 0:01:07.959 --> 0:01:09.880 of the crazy things we're going to be talking about today. 0:01:09.920 --> 0:01:13.040 Because when I think about surgery for Prayerroni's, especially the 0:01:13.040 --> 0:01:16.200 more involved ones. It is some of the most delicate 0:01:16.360 --> 0:01:19.120 surgery we do in all of medicine. I mean, you 0:01:19.160 --> 0:01:22.160 think about spine surgery, sure, you think about neurosurgery, sure, 0:01:22.600 --> 0:01:24.199 But for us to be able to do a really 0:01:24.240 --> 0:01:28.759 good job on a Peroni surgery where we're the granddaddy 0:01:28.760 --> 0:01:30.880 of them all, which I'm sure we'll get into something 0:01:30.880 --> 0:01:33.800 called a plaque dexcision and graft, we essentially have to Jordan, 0:01:33.840 --> 0:01:35.360 I'm glad you're sitting down for this, and if you 0:01:35.440 --> 0:01:37.240 want to take some Sofran, now is the time to 0:01:37.240 --> 0:01:39.880 do it, because I know you get a little queasy. 0:01:39.600 --> 0:01:43.280 But we essentially have to disassemble most of the penis 0:01:43.800 --> 0:01:47.000 to fix the disease state and then reassemble it. And 0:01:47.240 --> 0:01:49.120 you got to do everything perfectly in order for a 0:01:49.120 --> 0:01:50.320 guy to have a good outcome. And so we're going 0:01:50.360 --> 0:01:52.240 to break down that as well as just kind of 0:01:52.280 --> 0:01:55.320 what we guys have to go through to get to 0:01:55.360 --> 0:01:58.200 that state, as well as what are the options and surgery. 0:01:57.920 --> 0:01:59.600 So, Matt, how's it going. 0:01:59.640 --> 0:02:01.160 I'm going to introduce you here in a second, but 0:02:01.240 --> 0:02:02.960 you look like you're in your your coat, You're in 0:02:03.000 --> 0:02:03.800 your scrubs like me. 0:02:03.920 --> 0:02:05.520 So it looks like we both have an our day 0:02:05.560 --> 0:02:05.800 to day. 0:02:06.560 --> 0:02:10.400 I'm I just did a consult. I'm actually on admin today, 0:02:10.400 --> 0:02:13.480 so this is a nice, perfect opportunity. But yeah, I'm 0:02:13.520 --> 0:02:17.480 really grateful for this opportunity. I've been I've been listening 0:02:18.600 --> 0:02:22.399 enthusiastically to your podcast. Here. What an honor to be here. 0:02:22.600 --> 0:02:24.440 Oh come on, now, this is great, I mean an 0:02:24.440 --> 0:02:27.640 honor for you. This is Matt Ziegelman here, professor of 0:02:27.760 --> 0:02:31.040 Urology at Mayo Clinic. He grew up born and raised 0:02:31.040 --> 0:02:32.800 really in the great state of North Dakota and went 0:02:32.840 --> 0:02:35.799 to North Dakota State along with Phil Jackson, Carson Wentz, 0:02:35.840 --> 0:02:38.440 who else am I forgetting? I mean notable alumni, including 0:02:38.480 --> 0:02:44.120 you professor here theoclinic. But he's also been really trained 0:02:44.160 --> 0:02:46.040 at some of the better programs in the country, including 0:02:46.320 --> 0:02:49.560 doing his fellowship in Male sexuals Dysfunction at RUSH in 0:02:49.680 --> 0:02:51.679 Chicago with Larry the Vine of the one of the 0:02:51.720 --> 0:02:52.640 giants in our field. 0:02:52.680 --> 0:02:53.120 As well. 0:02:53.800 --> 0:02:55.520 He is on the board of directors for the Sexual 0:02:55.600 --> 0:02:57.680 Medicine Society of North America, which was one of our 0:02:57.760 --> 0:03:01.639 premier and actually the premier section medicine society really in 0:03:01.680 --> 0:03:03.720 the country and therefore also in the world along with 0:03:03.760 --> 0:03:06.440 the International Society of Sexual Medicine. I shot out these 0:03:06.480 --> 0:03:08.760 guys all the time and the work they do, and 0:03:08.800 --> 0:03:13.760 he's really fully, fully, so focused. We'll fix that one 0:03:13.760 --> 0:03:16.960 and post solely focused. Now, don't just let her up. 0:03:17.360 --> 0:03:21.280 He is solely focused. One of the rare guys like 0:03:21.360 --> 0:03:24.720 me really that just do sexual medicine in men's health 0:03:24.720 --> 0:03:27.280 and perone's disease. And being at the Mayo Clinic, I'm 0:03:27.280 --> 0:03:30.200 sure he's seen a lot of cases that really very 0:03:30.200 --> 0:03:32.320 difficult for anybody else to take care of. So that's 0:03:32.360 --> 0:03:35.320 why I brought you in, Professor Ziegelman, to talk to 0:03:35.440 --> 0:03:37.760 us about some of the surgical management since we've we've 0:03:37.760 --> 0:03:40.800 gone over interleagional therapy. But I'll get your I'll get 0:03:40.840 --> 0:03:42.800 your opinion on that because one of the things that 0:03:42.840 --> 0:03:45.440 I really want to really start with is if we're 0:03:45.480 --> 0:03:47.960 if we look at what we always say, the pills 0:03:47.960 --> 0:03:52.400 and pokes and procedures of Payerne's disease, that's another four piece, 0:03:52.520 --> 0:03:54.800 like we have the five piece of the pinocalypse. Now 0:03:54.800 --> 0:03:57.760 we have bills, folks, procedures Payne's. But but you know, 0:03:57.800 --> 0:04:00.280 how does a guy get to your OAR. I think 0:04:00.280 --> 0:04:03.400 it's one of the things that we're going to unpack. 0:04:03.480 --> 0:04:06.800 But let's start with that. When you see a guy 0:04:06.880 --> 0:04:09.640 and you're counseling him and say, he's already seen like 0:04:09.720 --> 0:04:12.480 many of your patients, three or four other urologists, and 0:04:12.520 --> 0:04:14.640 he comes in and says, Professor Ziegelmann, I want you 0:04:14.680 --> 0:04:15.400 to operate on me. 0:04:15.600 --> 0:04:17.080 How does that conversation start. 0:04:17.960 --> 0:04:21.760 Yeah, a great question. I still like to start from scratch, 0:04:21.960 --> 0:04:24.359 to be honest. I mean, when I see my patients, 0:04:24.440 --> 0:04:28.279 it's tell me you know when this started, Like catch 0:04:28.360 --> 0:04:31.200 me up to speed. The is the phrase I like 0:04:31.279 --> 0:04:36.000 to use. And then I do a formal assessment in 0:04:36.040 --> 0:04:40.200 the office and then we start the conversation with I 0:04:40.279 --> 0:04:42.800 know you've been through some of these options. I know 0:04:42.920 --> 0:04:47.280 you've talked through other options with other clinicians. But let 0:04:47.320 --> 0:04:50.080 me just tell you what I think about traction. Let 0:04:50.080 --> 0:04:53.240 me tell you what I think about injections, let me 0:04:53.240 --> 0:04:56.520 tell you what I think about surgery specific to your case. 0:04:57.279 --> 0:05:00.640 And I think it's important to just emphasize to our 0:05:00.760 --> 0:05:05.320 patients that we are multifacet in our approach. And I 0:05:05.360 --> 0:05:07.640 just don't want somebody to think that even if they 0:05:07.680 --> 0:05:11.120 come in asking for surgery that I'm that's all that 0:05:11.160 --> 0:05:14.440 we have to offer. If nothing out that nothing else, 0:05:14.480 --> 0:05:18.560 excuse me. That just builds trust that we are in 0:05:18.640 --> 0:05:22.160 this together and we're you know, we're not just out there, 0:05:22.400 --> 0:05:24.600 you know, willy nilly cutting on. 0:05:24.920 --> 0:05:28.400 As Yeah, I think that's I mean, that's especially with 0:05:28.560 --> 0:05:33.120 Perroni's surgery, where side effects and the adverse events are 0:05:33.480 --> 0:05:36.120 are high. And you know, we we joke that if 0:05:36.279 --> 0:05:39.280 if you're a hand surgeon, you have ten fingers. So 0:05:39.520 --> 0:05:41.440 even if you know you don't have the great day 0:05:41.440 --> 0:05:44.120 in the oar, you still have nine fingers and most 0:05:44.160 --> 0:05:47.600 guys you get one penis. And therefore, like we got 0:05:47.640 --> 0:05:49.839 to be spot on, we gotta do. You can you 0:05:49.839 --> 0:05:51.960 can laugh while go on by Jordan, I mean that 0:05:52.000 --> 0:05:56.600 beautiful smile of yours. But yeah, we really, uh, we 0:05:56.640 --> 0:05:59.159 really do though. I mean, it's it's something that that 0:05:59.600 --> 0:06:01.680 you can't just jump in and shake your guy's hand 0:06:01.720 --> 0:06:03.279 and say I'll book you next Wednesday. 0:06:04.080 --> 0:06:05.360 So I think that's important. 0:06:05.720 --> 0:06:07.760 Talk to me about what you think if a guy 0:06:07.839 --> 0:06:11.240 comes in in a cute versus chronic phase. We've defined 0:06:11.279 --> 0:06:13.520 these and as you know from all the times we've 0:06:13.560 --> 0:06:15.560 been on stage to get everything else. I'm not a 0:06:15.640 --> 0:06:18.680 huge fan of acute and chronic in terms of six 0:06:18.760 --> 0:06:21.440 months to eighteen months or twelve months, or it's more 0:06:21.839 --> 0:06:24.640 sort of symptoms. But there is there a guy that 0:06:24.720 --> 0:06:27.400 it's too soon to operate on. How do you counsel 0:06:27.480 --> 0:06:29.760 somebody in terms of their disease state and what they've 0:06:29.800 --> 0:06:32.560 been through before they go to the OAR with you. 0:06:33.520 --> 0:06:37.760 Yeah, the dichotomy of active or acute versus chronic is 0:06:38.640 --> 0:06:41.280 kind of troublesome in a lot of ways, especially as 0:06:41.320 --> 0:06:45.320 we define who's a good candidate for surgery. You know, 0:06:45.360 --> 0:06:47.560 the guy who comes in and says, my symptoms started 0:06:47.560 --> 0:06:50.919 six weeks ago and I've noticed change over that period. 0:06:50.960 --> 0:06:53.800 That's not somebody where I'm going to feel enthusiastic about 0:06:53.800 --> 0:06:56.800 offering surgery. I usually like to just explain the rationale 0:06:56.839 --> 0:07:00.960 for waiting until we see things stay eyes. I feel 0:07:00.960 --> 0:07:05.920 comfortable with three months of stable symptoms, and you rely 0:07:06.000 --> 0:07:08.279 on the patient for that. It's not like I'm doing 0:07:08.320 --> 0:07:11.600 an assessment at three months, six months, nine months to 0:07:11.640 --> 0:07:14.040 prove that. I'm just explaining to the patient that if 0:07:14.040 --> 0:07:16.360 we operate too soon, you may still be in this 0:07:16.480 --> 0:07:20.880 period of active dynamic change and we may be operating 0:07:21.000 --> 0:07:25.240 on something before it's fully defined. Yeah, So I mean 0:07:25.280 --> 0:07:30.320 it's just generally probably around you know, six symptom duration 0:07:30.480 --> 0:07:33.760 of six months with stability for three months, So no 0:07:33.920 --> 0:07:36.240 change in your symptoms for three months. I feel pretty 0:07:36.360 --> 0:07:39.720 confident beyond that. But if at six months they say no, 0:07:39.960 --> 0:07:43.280 last month it was it was much better than it 0:07:43.360 --> 0:07:44.880 is today, I'm going to go hold on and we 0:07:44.920 --> 0:07:46.560 need to wait a little longer. So it is a 0:07:46.720 --> 0:07:49.200 it is a individualized decision. 0:07:49.640 --> 0:07:49.880 Yeah. 0:07:49.920 --> 0:07:52.800 I think that that that's the key as well for me, 0:07:52.920 --> 0:07:55.840 is that if if you go too soon, you could 0:07:55.840 --> 0:07:59.320 either undercorrect or overcorrect. If they're on any kind of therapy, 0:07:59.400 --> 0:08:01.640 that that may be changing this a little bit. And 0:08:01.800 --> 0:08:03.960 that that stable phase three month sounds like a pretty 0:08:04.000 --> 0:08:05.600 good time, And I think I don't. I don't have 0:08:05.680 --> 0:08:08.320 that exact cutoff either, but it just seems right and 0:08:08.320 --> 0:08:10.400 and I do. And you know, I'm sure you see 0:08:10.680 --> 0:08:12.960 the same patients that come in and say, you know, 0:08:12.960 --> 0:08:14.480 it took me forever to get in here, and I 0:08:14.600 --> 0:08:15.400 just you know, I got it. 0:08:15.440 --> 0:08:16.960 I need a plan, I need to do this now. 0:08:17.040 --> 0:08:19.520 And that's one of the things that we have to 0:08:19.560 --> 0:08:23.400 do in pernis is set those expectations and and so 0:08:23.480 --> 0:08:25.920 that's my next question for you, is how do you 0:08:26.040 --> 0:08:30.400 set expectations for Peroni's Because, as we talked about, I mean, 0:08:30.400 --> 0:08:33.240 this is you know, our our penis. The penis is 0:08:33.920 --> 0:08:37.599 such a it's such a big part of our identity 0:08:37.640 --> 0:08:40.840 and our psyche. And when we get Parone's disease, whether 0:08:40.920 --> 0:08:44.680 you get curvature or shortening or hourglassing or hinging, all 0:08:44.720 --> 0:08:48.160 the different form fruits that we've talked about on this 0:08:48.520 --> 0:08:51.199 on the show, then you're never going to get that 0:08:51.280 --> 0:08:54.600 same penis back. But how do you tell a guy, 0:08:54.640 --> 0:08:55.880 how are you going to get from where you are 0:08:55.880 --> 0:09:00.480 in my office miserable and life altered to the point 0:09:00.480 --> 0:09:03.040 where you're happy or at least satisfied with the outcome. 0:09:03.080 --> 0:09:04.640 Talk to me about expectations. 0:09:06.040 --> 0:09:10.280 The most important and the most challenging part of I 0:09:10.320 --> 0:09:13.280 think the practice. I mean, yes, the surgery is intricate, 0:09:14.200 --> 0:09:17.320 there are nuances to the non surgical treatments, but I 0:09:17.320 --> 0:09:21.320 think one of the most like one of the things 0:09:21.360 --> 0:09:23.680 that helps define a really good clinician in this space 0:09:23.800 --> 0:09:26.560 is is their ability to counsel patients, and one is 0:09:26.559 --> 0:09:29.720 to empathize with patients and just acknowledge that you know 0:09:29.760 --> 0:09:32.360 where you're at today and where you were at before 0:09:32.400 --> 0:09:35.760 this all started are two very different points. And unfortunately, 0:09:36.120 --> 0:09:38.280 and always say that up front, we're not going to 0:09:38.320 --> 0:09:40.560 get you back there. I mean, it's it's imperative that 0:09:40.640 --> 0:09:44.839 we emphasize that we don't want to. That just sets 0:09:44.880 --> 0:09:47.760 the wrong sort of the wrong tone if we If 0:09:47.840 --> 0:09:52.040 patient leaves my office and thinks, you know, I'm I'm 0:09:52.040 --> 0:09:53.880 going to get back the penis I had before, that 0:09:53.880 --> 0:09:56.200 doesn't mean there isn't a lot of hope and a 0:09:56.240 --> 0:09:59.920 lot of enthusiasm, but just acknowledging that upfront, and then 0:10:00.080 --> 0:10:02.560 I like to use the idea of you know where 0:10:02.559 --> 0:10:06.119 you're at today and you can think back to yesterday 0:10:06.200 --> 0:10:09.559 i e. When this all started and say that was 0:10:09.600 --> 0:10:12.479 a great place to be my that was a great penis. 0:10:13.240 --> 0:10:15.400 Now but now if we're going to talk about what 0:10:15.480 --> 0:10:18.520 I can do for you, we need to use today 0:10:18.559 --> 0:10:21.280 as the reference point. And so my goal is that 0:10:21.400 --> 0:10:24.760 tomorrow i e. After treatment, you say to yourself, I'm 0:10:24.800 --> 0:10:28.160 in a better place than I was today. And so 0:10:28.200 --> 0:10:32.480 that's the that's the counseling point that I've found lands 0:10:32.480 --> 0:10:35.480 with patients and I think it makes it makes intrinsic 0:10:35.559 --> 0:10:40.800 sense to me as well. Sometimes that's a really hard 0:10:40.840 --> 0:10:43.560 thing for patients to hear, and I mean we you know, 0:10:43.600 --> 0:10:46.080 we see tears sometimes. I mean, this is such a 0:10:46.120 --> 0:10:49.160 devastating thing for men. But at the end of the day, 0:10:49.480 --> 0:10:53.560 I think that you know, the many times those men 0:10:53.840 --> 0:10:55.760 once once they hear that, and they hear that you're 0:10:55.800 --> 0:10:57.800 still here to partner with them and there are still 0:10:57.800 --> 0:11:00.640 things that you can do, they still leave with help. 0:11:01.040 --> 0:11:04.040 And that's you know that for a better for a 0:11:04.080 --> 0:11:07.760 better life, a better penis a better better sexual function, 0:11:08.679 --> 0:11:10.720 better intimacy than they they're currently envying. 0:11:10.760 --> 0:11:14.760 Yeah, yeah, I think it's we always emphasize that we 0:11:15.080 --> 0:11:19.439 try to restore function, and that's that's the best expectation 0:11:19.559 --> 0:11:22.800 that I can set for any surgical candidate. And that's 0:11:22.840 --> 0:11:27.600 critical because there are guys that will never be able 0:11:27.679 --> 0:11:29.679 to kind of get back to where they were in 0:11:29.720 --> 0:11:32.520 their prime. And I find it's you know, sort of 0:11:32.559 --> 0:11:35.839 like talking with athletes, and you know that that when 0:11:35.880 --> 0:11:38.559 you were eighteen, when you were twenty two, you probably 0:11:38.679 --> 0:11:41.160 could throw a one hundred and two mile an hour fastball, 0:11:41.200 --> 0:11:42.800 and maybe by the time you got to twenty six, 0:11:42.840 --> 0:11:45.440 you started to lose a little velocity. But you know, 0:11:45.480 --> 0:11:48.240 can you go still play a good game of baseball 0:11:48.280 --> 0:11:49.320 when you're fifty? 0:11:49.440 --> 0:11:49.640 You know? 0:11:49.679 --> 0:11:51.000 I mean it's not the game you played when you 0:11:51.040 --> 0:11:53.840 were twenty five, but but you still got some some 0:11:54.000 --> 0:11:56.920 hunt and some fight left, pinion. And that's about the 0:11:56.920 --> 0:11:59.920 best we can do. So how do you how do 0:12:00.200 --> 0:12:03.760 you prepare somebody for surgery? And we're going to spend 0:12:03.960 --> 0:12:06.200 the last half of this. The next half of is 0:12:06.240 --> 0:12:08.800 just talking about the various options and who are candidates. 0:12:08.800 --> 0:12:11.200 But before you get to that point, talk to me 0:12:11.240 --> 0:12:14.679 about your pre opt talk your preparation. Do you talk 0:12:14.720 --> 0:12:18.560 about nutrition, hormone management, just you know, get somebody ready 0:12:18.559 --> 0:12:20.040 for your O war. If I'm flying all the way 0:12:20.040 --> 0:12:22.200 to Minnesota, I want to know you know what my 0:12:22.480 --> 0:12:23.560 soup and nuts are here? 0:12:23.679 --> 0:12:27.520 Yeah? Yeah, I mean the ultimately, the line I like 0:12:27.600 --> 0:12:29.600 to use is that if it's good for your heart, 0:12:29.640 --> 0:12:32.920 it's good for your penis. So generally, anything we can 0:12:33.000 --> 0:12:37.240 do to optimize your your general health status is going 0:12:37.280 --> 0:12:41.400 to optimize our outcomes with surgery. And that's particularly important 0:12:41.440 --> 0:12:45.600 as we're going to talk about with the sort of 0:12:45.679 --> 0:12:50.080 the most invasive surgery. But the you know, the plaque 0:12:50.080 --> 0:12:53.680 incision or partial black excision and grafting. But generally we 0:12:53.720 --> 0:12:56.880 want to optimize sexual function, which goes beyond just a 0:12:56.920 --> 0:13:01.200 straight penis or a straight or penis, and that starts 0:13:01.240 --> 0:13:05.040 with stress management, which is hard when patients are dealing 0:13:05.040 --> 0:13:08.800 with something stressful. Payerne's disease right not to mention everything 0:13:08.800 --> 0:13:12.680 else going on in their life. Starts with diet, starts 0:13:12.720 --> 0:13:16.280 with exercise, starts with sleep hygiene. All of those things 0:13:16.320 --> 0:13:20.760 aren't unique to Payne's disease. But every patient that we see, 0:13:20.880 --> 0:13:25.360 especially in the setting of sexual function and dysfunction, you know, 0:13:25.480 --> 0:13:28.079 probably has opportunities as do the rest of us, as 0:13:28.120 --> 0:13:32.000 does everybody. So like I like to have a conversation 0:13:32.080 --> 0:13:35.120 about that with all my patients, regardless of whether they're 0:13:35.160 --> 0:13:38.480 having surgery or not. You know, we generally like our 0:13:38.520 --> 0:13:43.040 patients to have a medical evaluation prior to considering a 0:13:43.080 --> 0:13:48.160 surgical intervention, just overall health and well being. But as 0:13:48.160 --> 0:13:50.200 far as penile health, yeah, I just spent some time 0:13:50.240 --> 0:13:55.560 counseling them about just lifestyle optimization, cardiovascular health and even 0:13:55.600 --> 0:13:58.640 psycho psychosexual health is another thing that you will make 0:13:58.679 --> 0:14:02.040 sure our patients all that you know, while yeah, in 0:14:02.080 --> 0:14:04.479 some ways I feel like, uh, you know, the glorified 0:14:04.559 --> 0:14:08.880 plumber sometimes, but uh, but we have experts who who 0:14:08.920 --> 0:14:11.920 can really help them, you know, identify other ways that 0:14:11.960 --> 0:14:17.080 there their psychological effect can be influencing the outcome we 0:14:17.080 --> 0:14:19.880 can get with surgery. So I have no no concerns whatsoever. 0:14:20.040 --> 0:14:23.400 In fact, encourage most patients to think about a psychosexual 0:14:23.440 --> 0:14:26.560 health EMIL if we have the time and resources to 0:14:26.640 --> 0:14:26.920 do so. 0:14:29.800 --> 0:14:49.440 H general health equals genital health. 0:14:50.080 --> 0:14:52.800 And just like a good plumber, you can tell people 0:14:52.840 --> 0:14:55.080 to keep potato peels out of your garbage disposal and 0:14:55.120 --> 0:14:57.840 prevent a lot of bad things. And so I think 0:14:57.880 --> 0:15:01.000 are I think keeping French fries to your diet maybe 0:15:01.120 --> 0:15:04.720 is the same thing new make sure you're startaway from 0:15:04.840 --> 0:15:08.880 ultra process foods and vacant calories and and that helps. 0:15:08.880 --> 0:15:11.760 But I love the fact that that you do what 0:15:11.840 --> 0:15:15.640 you do as as this surgeon, that people are coming 0:15:15.760 --> 0:15:17.960 literally from all over the world to have you operate them, 0:15:18.440 --> 0:15:21.640 and you still go with the fundamentals of eat, move, 0:15:21.720 --> 0:15:24.360 sleep and the mental health aspect of it, because I 0:15:24.400 --> 0:15:26.360 think a lot of these guys we deal with are 0:15:26.800 --> 0:15:32.640 emotionally devastated and it's amazing how few, even really high 0:15:32.760 --> 0:15:36.720 level Peroni thegnicians don't spend enough time at least when 0:15:36.720 --> 0:15:38.880 we're at these meetings talking about that mental health component. 0:15:38.920 --> 0:15:41.800 One of the biggest things about the show that we've 0:15:42.280 --> 0:15:43.680 I think it's evolved organically. 0:15:43.760 --> 0:15:44.760 Jordan, you can chime in. 0:15:44.800 --> 0:15:47.280 But but early on we had a therapist on that 0:15:47.360 --> 0:15:50.560 talked about the shame factor and men and we Stephen 0:15:50.560 --> 0:15:53.520 Polter was his name, and he he almost kind of 0:15:53.520 --> 0:15:55.040 framed a lot of what we talk about. The most 0:15:55.040 --> 0:15:57.520 of what we have to deal with in men's health 0:15:57.640 --> 0:16:00.400 deals with the idea of shame and Peroni I think 0:16:00.520 --> 0:16:04.040 is is target zero for that where you know, if 0:16:04.120 --> 0:16:07.440 you are used to as you were saying, you know 0:16:07.440 --> 0:16:09.640 your penis as it was yesterday, and then now you're 0:16:09.680 --> 0:16:12.360 in Siegelman's office today and it ain't the same penis 0:16:12.400 --> 0:16:15.760 it was yesterday, it's hard not to carry some shame 0:16:15.800 --> 0:16:18.000 about what happened, like did I do this to myself? 0:16:18.160 --> 0:16:19.040 Did you know? 0:16:19.080 --> 0:16:21.640 Did I do something wrong to get to this level? 0:16:21.680 --> 0:16:24.040 And we talked about that in a couple of previous 0:16:24.080 --> 0:16:27.120 episodes about do you know that there is this is a. 0:16:27.080 --> 0:16:29.240 Guilt free condition. 0:16:29.440 --> 0:16:31.800 It just happens like, you don't shame yourself if you 0:16:31.800 --> 0:16:34.800 get appendicitis. It's not because you had too many holopeno 0:16:34.840 --> 0:16:37.840 peppers or something. It's just, you know, it just happens 0:16:37.880 --> 0:16:39.840 and we have to take care of it. So I 0:16:39.880 --> 0:16:42.720 love that you. I love you hit all those and 0:16:42.720 --> 0:16:45.040 and so talk to me a little bit then about 0:16:45.160 --> 0:16:49.560 the physical prep. You know, so good nutrition, great, increase protein, 0:16:49.680 --> 0:16:52.560 increase your exercise, get your heart pumping. Do you do 0:16:52.640 --> 0:16:56.080 anything pino specific? I think I just made that word up. 0:16:56.120 --> 0:16:57.920 But I like it. I like it. 0:16:57.880 --> 0:17:02.200 Pinos specific track v D ahead of surgeries. Talk to me, 0:17:02.280 --> 0:17:04.639 I'm sorry, a vacuum erection device, I should say, or 0:17:04.680 --> 0:17:07.680 the Austin Powers chamber as we affect it. 0:17:08.520 --> 0:17:11.800 I U use that reference it. Uh, you gotta find 0:17:11.800 --> 0:17:15.920 your target demographic as far as knowing who's who's seen 0:17:15.960 --> 0:17:19.320 Austin Powers or not. But what a what a great 0:17:19.359 --> 0:17:20.359 reference point. 0:17:21.880 --> 0:17:22.159 We do? 0:17:22.400 --> 0:17:26.920 Yeah? I mean so, I'm a big proponent of mechanical 0:17:27.040 --> 0:17:31.480 mechanical therapy and that I basically tell patients as part 0:17:31.520 --> 0:17:35.879 of any treatment protocol, whether it's by itself or in 0:17:35.960 --> 0:17:40.119 combination with things like interllagional injections, like injections of ziaflex 0:17:41.000 --> 0:17:46.560 or or pre and or post surgical. I think that there, 0:17:46.800 --> 0:17:51.400 especially if we're sort of still defining you are you 0:17:51.560 --> 0:17:55.560 are you ready for surgery, either physically based on our 0:17:55.880 --> 0:17:59.280 criteria that we've set up for you know, who's a 0:17:59.320 --> 0:18:02.000 time wise who a good candidate, or just mentally some 0:18:02.040 --> 0:18:06.480 patients just aren't mentally quite there yet. And that's where 0:18:06.720 --> 0:18:12.040 mechanical therapy is doing something right. It's active, the patient's 0:18:12.119 --> 0:18:15.879 involved in it. It gives them time to literally it 0:18:15.920 --> 0:18:17.959 takes time, right, so it gives them time to focus 0:18:18.000 --> 0:18:20.800 on their penis, but also to kind of think about 0:18:21.200 --> 0:18:23.199 why they're doing this, like why are they putting in 0:18:23.240 --> 0:18:26.240 all this time and effort. And at the end of 0:18:26.240 --> 0:18:30.879 the day, the outcomes are that most men see enhanced elasticity, 0:18:31.119 --> 0:18:34.320 so more stretch on the penis. I hopefully that translates 0:18:34.400 --> 0:18:38.320 into more length. It's not necessarily what you've lost, but 0:18:39.240 --> 0:18:43.240 improve nonetheless, And lots of men see decrease in their curvature. 0:18:43.400 --> 0:18:49.000 So if anything, that's priming us to optimize our surgical outcomes, 0:18:49.080 --> 0:18:51.239 meaning if the curves a little less and we're going 0:18:51.280 --> 0:18:53.840 to talk about plication, right, maybe that means one less 0:18:53.840 --> 0:18:56.639 suit dra have to put in. If there's more elasticity, 0:18:56.760 --> 0:18:59.320 maybe when it's all said and done, their penis is 0:18:59.359 --> 0:19:02.080 able to stretch, or they're happier with the length, or 0:19:02.119 --> 0:19:05.000 they have less perceived length loss with the surgery. That's great, 0:19:05.400 --> 0:19:08.879 And regardless of what surgery we do, I encourage all 0:19:09.000 --> 0:19:13.119 patients to use traction afterwards. Not everybody takes us up 0:19:13.160 --> 0:19:15.359 on that, right, I mean, if they're happy with their 0:19:15.400 --> 0:19:19.720 outcome and they're ready to kind of move on from 0:19:19.800 --> 0:19:23.000 this awesome right, But for a lot of men who 0:19:23.040 --> 0:19:26.040 are really looking to optimize not only the straightness of 0:19:26.080 --> 0:19:29.320 the direction but also size, that's where doing traction post 0:19:29.440 --> 0:19:32.200 up is a great adjunct. And vacuum's fine too, It's 0:19:32.240 --> 0:19:35.840 just the data is more pronounced with or is more 0:19:35.920 --> 0:19:36.760 prominent with traction. 0:19:37.240 --> 0:19:39.440 Yeah, I mean, talk to me about the science of 0:19:39.760 --> 0:19:42.040 attraction a little bit, because I know a lot of 0:19:42.080 --> 0:19:45.040 this just came out of the Mayo clinic. So tell 0:19:45.119 --> 0:19:48.280 us about, you know, what's actually happening mechanically. Maybe even 0:19:48.320 --> 0:19:52.160 explain to Jordan and everybody else out there what attraction 0:19:52.640 --> 0:19:55.520 device is and because I'm sure everybody's googling it and 0:19:55.560 --> 0:19:57.720 then I can only imagine what comes up. But it's 0:19:57.760 --> 0:20:00.960 probably you know, if restauran is good at their SEO, 0:20:01.040 --> 0:20:02.800 they probably are coming up pretty high up in the liz. 0:20:03.800 --> 0:20:05.480 But yeah, talk to us about the science of what 0:20:05.920 --> 0:20:07.320 traction does to the penis. 0:20:07.840 --> 0:20:11.600 So this way oversimplified way to think about it is 0:20:11.640 --> 0:20:15.840 you're using a mechanical device to stretch the penis, right, 0:20:15.920 --> 0:20:21.280 and so with traction there's different mechanisms, but basically there's 0:20:21.280 --> 0:20:23.480 something that holds the head of the penis and then 0:20:23.480 --> 0:20:26.280 there's something that actually puts the flacid, so the non 0:20:26.280 --> 0:20:30.280 erect penis on stretch. And if you think about like 0:20:30.320 --> 0:20:33.040 stretching a muscle, right like I went for on this morning, 0:20:33.080 --> 0:20:35.879 my calf is tight. I'm going to stretch that calf 0:20:35.960 --> 0:20:38.600 out if I don't do that every day, and all right, 0:20:38.760 --> 0:20:40.320 stretch it for a while and it feels great, and 0:20:40.359 --> 0:20:42.520 then I say, okay, good, I'm done. I'm gonna stop. 0:20:43.520 --> 0:20:45.359 In a few days, my calf is going to be 0:20:45.400 --> 0:20:47.080